Cranial surgical drape

ABSTRACT

A drape for use in cranial surgical procedures including a sterile sheet and a plurality of fluid-collection reservoirs surrounding a cranial region fenestration. The drape further can include a thoracic region fenestration for concurrent or directly subsequent thoracic surgical procedures. Advantageously, the drape allows for a superior aseptic surgical field and superior drainage facilitated by a multi-pouch configuration.

RELATED APPLICATIONS

This application does not claim priority to any preceding application orpatent.

FIELD OF INVENTION

The present technology, in general, relates to a cranial surgical drape.More particularly, the present technology relates to a cranial surgicaldrape with a fluid-collection pouch reservoirs which reduces potentialsurgical field contamination and effectively collects any irrigating andbodily fluids. Moreover, the cranial surgical drape has an additionalopening for thoracic procedures and other features that facilitatecranial surgical procedures.

BACKGROUND OF INVENTION

A patient undergoing a surgical procedure is generally at leastpartially covered by a surgical drape. The surgical procedure is oftenperformed through a fenestration (which can be a window, slit, or otheropening) in the drape. The importance of surgical draping in providingan aseptic field about the central operative area is well known. It iscommon practice for many types of surgery to cover the patient andoperating table with a sterile drape in such a way that only the portionof the body upon which surgery is to be performed is presented to thesurgeon. The drape must conform rather closely to the contour of theoperative area to insure that a sterile surgical field is maintaineduntil the procedure is completed. One of the objectives of some surgicaldrapes is to disperse fluid runoff from the surgical site so that itdoes not obstruct the working of the surgeon and so that it does notsoil the patient. It is presently common practice to furnish or employvarious types of drape constructions and draping procedures fordifferent types of surgical procedures.

Certain types of surgeries result in only a small amount of fluid runofffrom the surgical site. In these cases, the fluid may be simplydispersed across the surface of the drape; some drapes are produced withan absorbent exterior surface in order to absorb such fluid runoff. Incontrast to those types of surgeries, cranial surgeries often result ina substantial amount of fluid runoff from the surgical site. In cranialsurgical cases, the surgical drape is used to channel these fluids intoa receptacle. One such receptacle is a pouch attached to the exterior ofthe surgical drape. Drapes with such receptacles are disclosed in U.S.Pat. Nos. 4,890,628, 4,598,458, 4,559,937, 4,323,062, 4,169,472,3,955,569, 3,952,738, 3,911,912, and 3,791,382. However, due to thesingle drainage avenue for fluid collection, the surgeon is often forcedto re-adjust the drape or channeling means such that the fluids draininto the receptacle.

Certain cranial surgeries require the surgeon to remove a portion of theskull. This extracted cranial bone may be re-implanted in the patient'sskull at a later date. Current procedures include removing the cranialbone in a sterile fashion and freezing it in a deep-freezer forre-implantation at a later date. This practice presents various riskswhen a specimen is removed from the patient; handled and wrapped forfuture sterile, aseptic re-introduction; and then re-introduced to asterile field some time after harvesting. The technical requirements formonitoring and preserving the cranial bone ex-vivo are demanding due torisks of contamination and specimen deterioration. One current techniqueto avoid monitoring and preserving ex-vivo samples is to implant thecranial bone into the patient's own abdomen directly after extraction.This implantation allows for the cranial bone to remain in a sterileenvironment and with the patient until re-implantation is warranted.

BRIEF SUMMARY OF THE INVENTION

The present technology generally relates to a surgical drape used duringaseptic surgical procedures. More particularly, the present technologyrelates to a surgical drape ideal for cranial surgeries, though thepresent technology may be adapted for drapes for other types of surgicalprocedures. The present technology provides for a superior asepticsurgical field and superior drainage facilitated by a plurality offluid-collection reservoirs (or a plurality of fluid-collection pouches)adjacent to the surgical site.

The cranial surgical drape comprises a cranial region fenestration thatenables the surgeon access to the incision and surgical site. Further,the cranial surgical drape has a fluid collection pouch having multiplereservoirs designed to collect irrigating or bodily fluids which emanatefrom the surgical site. In a preferred embodiment of the cranialsurgical drape, an additional thoracic region fenestration is presentfor a concurrent, or directly subsequent, thoracic surgical procedure.

As one aspect of the present invention, a cranial surgical drape tocover a patient during surgery is provided. The drape comprises a sheethaving an interior surface for contacting the cranial region of asurgical patient and an exterior surface for facing away from thepatient after placement. The drape also comprises a fenestration in thecranial region, wherein the sheet has a perimeter that defines thefenestration. The drape further comprises a fluid-collection pouch onthe exterior surface of the sheet adjacent to and surrounding a majorityof the perimeter of the cranial region fenestration. Thefluid-collection pouch is fastened to the exterior surface and is influid communication with the cranial region fenestration.

As another aspect of the present invention, a cranial surgical drape tocover a patient during surgery is provided. The drape comprises a sheet(as described above), a fenestration in the cranial region of the sheet,and a fenestration in the thoracic region of the sheet. The sheet hasfirst and second perimeters that defines the fenestrations. The drapealso includes a fluid-collection pouch on the exterior surface of thesheet surrounding and adjacent the fenestration in the cranial regionfastened to the exterior surface and in communication with saidfenestration in the cranial region.

As yet another aspect of the present invention, a cranial surgical drapeto cover a patient during surgery is provided. The drape comprises asheet having an interior surface for contacting the cranial region of asurgical patient and an exterior surface for facing away from thepatient after placement. The drape also comprises a fenestration in thecranial region, wherein the sheet has a perimeter that defines thefenestration. The drape also includes a fluid-collection pouch on theexterior surface of the sheet adjacent to and surrounding a majority ofthe perimeter of the cranial region fenestration, wherein thefluid-collection pouch is fastened to the exterior surface and is influid communication with the cranial region fenestration. Thefluid-collection pouch comprises at least three reservoirs, and each ofthe reservoirs is on a different side of the cranial regionfenestration. The drape also include a malleable strip at a top openingof the reservoir adapted for maintaining the reservoir in an openconfiguration. A fenestration is provided in the thoracic region,wherein the sheet has a perimeter that defines the fenestration. Thedrape also comprises adhesive on the interior surface surrounding thecranial region and thoracic region fenestrations. The drape alsoincludes one or more cord fasteners.

As yet another aspect of the present invention, a packaged sterilesurgical drape is provided. The packaged sterile surgical drapecomprises a drape according to any of the embodiments described hereinand a package that contains the sterile surgical drape and maintains thesterility of the drape. In this aspect, the drape is a sterile drape.

In the various aspects and embodiments of the cranial surgical drapesdescribed herein, the fluid-collection pouch may comprise a plurality ofreservoirs. When the drape has a single fluid-collection pouch withmultiple reservoirs, it is desirable to have a reservoir on differentsides of the fenestration, preferably on at least three sides of thefenestration. Alternatively, a drape may include a plurality offluid-collection pouches, and it may be desirable to have each of thefluid-collection pouches on a different side of the fenestration.

The present surgical drapes can include an absorbent layer on theexterior surface, such as in a middle portion of the exterior surface.The absorbent layer can comprise any absorbent material suitable for asurgical drape, though pulp-based non-woven fabric is presentlypreferred. The drape can include any suitable material, such as spunbondpolypropylene.

In the present surgical drapes, the fluid-collection pouch can contain afilter. The drapes can also include one or more cord fasteners and/orone or more channels to provide fluid communication between thefenestration and the fluid-collection pouch.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the one embodiment of the cranial surgical drape laid flatand viewing the exterior surface. One pouch with three triangularreservoirs surrounds a majority of the perimeter of the fenestration andis adjacent to the cranial region fenestration. A cord fastener on theexterior surface of the cranial surgical drape can be used at thediscretion of the surgical team for uses including, but not limited to,fastening irrigation hose(s) and/or medical monitoring equipment. Afilter is shown here which inhibits solids from reaching the bottom ofthe fluid-collection reservoir. The fluid-collection pouch shown herecontains three access ports located in each fluid-collection reservoirat the furthest distance from the cranial region fenestration. Each portis sealed with a cap. A thoracic region fenestration is located directlybelow the cranial region fenestration on the longitudinal axis of thedrape.

FIG. 2 shows the cranial region fenestration and the thoracic regionfenestration in the cranial surgical drape.

FIG. 3 shows the front view of a fluid-collection pouch with threereservoirs without the cranial surgical drape or cranial regionfenestration.

FIG. 4 shows an absorbent layer which may be present in the middle ofthe exterior extending parallel to the longitudinal axis.

FIG. 5 shows the back view of a fluid-collection pouch with threereservoirs without the cranial surgical drape or cranial regionfenestration.

DETAILED DESCRIPTION OF THE INVENTION

The present inventors have recognized the desirability of a cranialsurgical drape which allows the surgeon a sterile operating field andwithout need to re-adjust the drape for fluid collection. Additionally,a single drape with multiple fenestrations enables the surgeon tomaintain two aseptic surgical fields—one for cranial procedures and onefor thoracic procedures—during one anesthetic session. The presentcranial surgical drape is designed to lay over the patient in alongitudinal orientation. The drape is designed to be positioned once atthe beginning of the surgical procedure and not be re-adjusted throughthe course of the procedure.

In the present drawings, like reference characters are utilized toidentify like parts throughout several views.

FIG. 1 illustrates a cranial surgical drape 1 which is particularlyadapted for use in craniotomy surgical procedures. Both the interior andexterior surfaces of the drape may comprise a polypropylene, or apulp-based non-woven fabric or another material suitable for a surgicaldrape. Preferably, the drape comprises spunbond polypropylene (which isalso known as SMS in the industry). Spunbond polypropylene provides thepatient with more comfort compared to other polypropylenes.

FIG. 2 shows a cranial surgical drape with two fenestrations. Thecranial surgical drape 1 can have certain length B and width Adimensions. In some embodiments of the present surgical drape, the drapedimensions can be about 100 to about 170 inches long B and about 60 toabout 100 inches wide A, alternatively about 110 to about 160 incheslong B and about 65 to about 95 inches wide A, alternatively about 120to about 150 inches long B and about 70 to about 90 inches wide A,alternatively about 130 to about 140 inches long B and about 75 to about85 inches wide A, alternatively about 135 inches long B and about 80inches wide A.

The shape of the fenestrations in the cranial surgical drape is notlimited. Preferably, the cranial region fenestration 3 is oval.Preferably, the thoracic region fenestration 4 is rectangular. On theinterior surface surrounding the cranial region and thoracic regionfenestrations, an adhesive can be provided which can be applied to thepatient's body. Thus, the present drapes can comprise an adhesive layeron the interior surface of the drape surrounding the cranial regionfenestration and/or the thoracic region fenestration. When the adhesiveis applied to the patient's body, this insures the drape remains closelyto the contour of the operative area resulting in the sterile fieldbeing maintained until the procedure is completed.

In a preferred embodiment, an absorbent layer 5 extends longitudinallyin a middle region of the drape. Preferably, the absorbent layer iscomprised of a pulp-based non-woven.

FIG. 4 shows the absorbent layer of the cranial surgical drape with twofenestrations. The absorbent layer 5 can have certain length B and widthC dimensions. The absorbent layer dimensions can be about 100 to about170 inches long B and about 10 to about 60 inches wide C, alternativelyabout 110 to about 160 inches long B and about 20 to about 50 incheswide C, alternatively about 120 to about 150 inches long B and about 25to about 45 inches wide C, alternatively about 130 to about 140 incheslong B and about 30 to about 40 inches wide C, alternatively about 135inches long B and about 36 inches wide C. The cranial regionfenestration 3 can have certain length O and width P dimensions. Thelength O can be between about 2 to about 14 inches, alternativelybetween about 4 and about 12, alternatively about 2 to about 10 inches;preferably, the length O is about 8 inches in length. The width P can bebetween about 6 to about 18 inches, alternatively between about 8 andabout 16 inches, alternatively about 10 to about 14 inches; preferably,the width P is about 12 inches. The thoracic region fenestration 3 canhave certain length Q and width R dimensions. The length Q can bebetween about 1 to about 12 inches, alternatively between about 2 andabout 10 inches, alternatively about 4 to about 8 inches; preferably,the length Q is about 6 inches. The width R can be between about 1 toabout 12 inches, alternatively between about 2 and about 10 inches,alternatively about 4 to about 8 inches; preferably, the width P isabout 6 inches. The distance from the thoracic region fenestration tothe terminus of the drape designed to cover the patient's feet U can bebetween about 35 and about 75 inches in length, alternatively betweenabout 40 and about 70 inches, alternatively between about 45 and about65 inches, alternatively between about 50 and about 60 inches;preferably, the distance U is about 53 inches. The distance between thecranial region fenestration and the thoracic region fenestration T canbe between about 25 and about 50 inches in length, alternatively about30 and about 45 inches, alternatively about 35 and about 40 inches;preferably, the distance T is about 37 inches. The distance from thecranial region fenestration to the end of the drape designed to lie overthe patient's head S can be between about 20 and about 45 inches inlength, alternatively about 25 to about 40 inches, alternatively about30 to about 35 inches; preferably, the distance S is about 31 inches inlength.

In another preferred embodiment, the cranial surgical drape may containa cord fastener 2 to secure medical equipment, including, but notlimited to irrigation tubes or medical monitoring equipment. The cordholder can be comprised of a clip, hook, snap, or strap; preferably, thecord holder is comprised of a Velcro strap.

FIG. 3 shows the front panel of a fluid collection pouch. FIG. 5 showsthe back panel of a fluid-collection pouch. The fluid-collection pouchcan be of any shape capable of holding fluid. Preferably, thefluid-collection pouch is rectangular. More preferably, the fluidcollection pouch is triangular.

The fluid collection pouch comprises a front panel 6 and a back panel 9joined along common side edges and defining a one or more fluidreceiving reservoirs therein with the open end positioned adjacent thecranial region fenestration 3. The one or more pouches should bearranged in an orientation such that the majority of the perimeter ofthe cranial region fenestration is bordered by one or morefluid-collection pouch openings. The fluid collection pouch ispreferably constructed of a flexible, fluid-impervious material such asa plastic film. Most preferably, the fluid-collection pouch isconstructed of polyethylene. It is preferred that the pouch is made of asubstantially clear material to allow inspection of collected fluidthrough the pouch material. The pouch is attached to the exteriorsurface with adhesive. Heat-activated sealants are also contemplated tosecure the pouches to the exterior surface. The sides of the pouch aresealed, preferably either by heat or adhesive. Sides are preferablysealed such that pouch tapers such that the corners forming eachreservoir is narrower than the top opening of the pouch. The plastic orother impervious material should be able to withstand the temperaturesand gases used during the sterilization process which includestemperatures in excess of 140° F. for ethylene oxide sterilization. Apreferred method of sterilizing the cranial surgical drape is ethyleneoxide sterilization. A particularly well suited film material forethylene oxide sterilization is polyethylene. With steam sterilization,the plastic selected must be able to withstand temperatures in the rangefrom 250° to 270° F.

In FIGS. 3 and 5, numerous measurements are listed to best describe howelements of the fluid-collection pouch are orientated. The length Drepresents the distance between the bottom of the centerfluid-collection reservoir and the top of the fluid-collection opening.D and D′ may or may not be the same length. Preferably, D and D′ can bebetween about 4 and about 20 inches in length, alternatively from about9 inches to about 12 inches in length. Most preferably, D and D′ areabout 10.5 inches in length. The length E represents the depthmeasurement of the filter within the fluid-collection pouch. E and E′may or may not be the same length. Preferably, E and E′ can be betweenabout 1 and about 10 inches in length, alternatively from about 4 inchesto about 6 inches. Most preferably, E and E′ are about 5 inches inlength. The length F represents the distance between the top of thefluid-collection opening and the filter. F and F′ may or may not be thesame length. Preferably, F and F′ can be between about 1 and about 10inches in length, alternatively from about 4 inches to about 6 inches.The length I represents a portion of the fluid-collection pouch whereone of the reservoirs is located. I and I′ may or may not be the samelength. Preferably, I and I′ can be between about 10 and about 20 inchesin length. Most preferably, I and I′ are about 14 inches in length. Thelength J represents the distance between the beginning of thefluid-collection reservoir and the beginning of the side opening of thefluid-collection pouch. J and J′ may or may not be the same length.Preferably, J and J′ can be between about 1 and about 10 inches inlength, alternatively from about 5 inches to about 7 inches. Mostpreferably, J and J′ are about 6 inches in length. The length Krepresents a portion of the fluid-collection pouch where one of thereservoirs is located. K and K′ may or may not be the same length.Preferably, K and K′ can be between about 5 and about 15 inches inlength. Most preferably, K and K′ are about 13 inches. In FIG. 3, thelength G represents the length of the side openings of thefluid-collection pouch. G can be between about 10 and about 30 inches inlength, alternatively between about 15 and about 25 inches. Preferably,G is about 18 inches. The length H represents the length of the topopening of the fluid-collection pouch. H can be between about 10 andabout 30 inches in length, alternatively between about 15 and about 25inches. Preferably, H is about 17.5 inches. In FIG. 5, the symbol Lrepresents the length of the top opening of the fluid-collection pouchand can be between about 10 and about 20 inches, alternatively betweenabout 12 to about 16 inches. Preferably, L can be about 14 inches. Thesymbol M represents the length of the side opening of thefluid-collection pouch and can be between about 8 and about 16 inches inlength, alternatively about 10 to about 14 inches. Preferably, M isabout 12.5 inches.

In an embodiment employing more than one pouch, each with one or morereservoirs, the fluid-collection pouch dimensions can be about 12 toabout 22 inches wide at the opening of the pouch and about 14 to about24 inches deep, alternatively, about 16 to about 20 inches wide andabout 17 to about 21 inches deep, alternatively about 18 inches wide andabout 19 inches deep.

In an embodiment employing one pouch with multiple reservoirs, thefluid-collection pouch dimensions can be about 30 to about 70 incheswide along the latitudinal axis of the drape and about 20 to about 60inches long along the longitudinal axis of the drape, alternatively,about 40 to about 60 inches wide and about 30 to about 50 inches long,alternatively about 45 to about 55 inches wide and about 35 to about 45inches long, alternatively about 52 inches wide and about 41 incheslong.

One or more fluid collection pouches are preferably attached to theexterior surface of the drape and each pouch is in fluid communicationwith the cranial surgical site fenestration when the drape and pouch arein their normal operational position on a patient. In a preferredembodiment, a fluid collection pouch is disposed on at least two sidesof the cranial region fenestration, alternatively at least three sides,alternatively on all sides of the fenestration. In some embodimentsshown in the Figures, one fluid-collection pouch is disposed on threesides of the cranial region fenestration and thereby surrounds amajority (actually at least about three-quarters) of the perimeter ofthe cranial region fenestration.

One or more fluid-collection pouches preferably contain a screen orfilter 7 which allows fluids to flow into the pouch opening and down tothe reservoir at the bottom of the pouch, but inhibits any solids fromreaching the reservoir. The filter 7 can be comprised of anysemi-permeable material or nonpermeable material with irrigation holesor slits. Preferably, the filter is comprised of a plastic or a plasticcoated metal. Most preferably, the filter is comprised of polyethylene.

In a preferred embodiment, malleable strips may be located at orinserted into the top opening of each fluid-collection pouch orreservoir to maintain each pouch in an open configuration (i.e., able toreceive fluids). These malleable strips can be constructed from a numberof materials such as plastic, metal or plastic coated metal.

In another preferred embodiment, an access port 8 is located in eachfluid-collection reservoir. The access port would enable the medicalstaff to take fluid samples from the fluid-collection reservoir.Further, it is contemplated to have connection fixtures on the accessport 8 to facilitate a connection with tubing, for example. Each accessport has a cap when the medical staff desires the access port to remainclosed.

In a further preferred embodiment, channels (such as rails or flaps) maybe included on the exterior surface of the drape to control fluidcontrol into the fluid-collection pouch(es). The channels can bepositioned so as to channel fluid from the fenestration to afluid-collection pouch. The channels can be attached to the exteriorsurface of the sheet. The channels may be located alongside but spacedfrom the fenestration in the cranial region such that when the exteriorsurface and the pouch are in their normal operational position, fluidrunoff from the fenestration in the cranial region flows through achannel into an opening of a pouch. Methods of channeling fluids in asurgical drape have been disclosed in U.S. Pat. Nos. 4,890,628 and4,169,472 and are hereby incorporated by reference.

Unlike other designs, the present drapes do not have separate pieceswhich can become misaligned or detached thereby creating a risk of fluidspilling over onto other areas of the patient, the surgical team or theoperating floor. Such hazards are especially apparent when the surgicalprocedure requires frequent movement and repositioning of the patient.

The present cranial surgical drapes can be provided as sterile drapes.Sterile means essentially free from live bacteria or other livemicroorganisms. The process of sterilization is known in the art andexamples include, but are not limited to, steam sterilization andethylene oxide sterilization. The sterile drape can be provided in apackage for containing the sterile surgical drape and optionally otheritems and for maintaining the sterility of the drape.

Some of the advantages of the present cranial surgical drapes stem fromthe unique fluid collection pouch configuration. The configurationallows the surgeon to work without concern of re-draping or changing theexisting draping configuration. Moreover, embodiments having anadditional fenestration in the thoracic region allows the surgeon toperform subcutaneous placement of cranial bone grafts which is oftenperformed in conjunction with certain cranial surgeries.

1. A cranial surgical drape to cover a patient during surgery, the drapecomprising: a sheet having an interior surface for contacting thecranial region of a surgical patient and an exterior surface for facingaway from the patient after placement; a fenestration in the cranialregion, wherein the sheet has a perimeter that defines the fenestration;and a fluid-collection pouch on the exterior surface of the sheetadjacent to and surrounding a majority of the perimeter of the cranialregion fenestration, wherein the fluid-collection pouch is fastened tothe exterior surface and is in fluid communication with the cranialregion fenestration.
 2. The drape of claim 1, wherein thefluid-collection pouch comprises a plurality of reservoirs, wherein eachof the reservoirs is on a different side of the fenestration.
 3. Thedrape of claim 1, wherein the drape comprises a plurality offluid-collection pouches, wherein each of the three fluid-collectionpouches is on a different side of the fenestration.
 4. The drape ofclaim 1, wherein the drape comprises an absorbent layer on the exteriorsurface.
 5. The drape of claim 4, wherein the absorbent layer comprisespulp-based non-woven fabric.
 6. The drape of claim 1, wherein the drapecomprises spunbond polypropylene.
 7. The drape of claim 1, wherein thedrape comprises an adhesive layer on the interior surface of the drapesurrounding the cranial region fenestration.
 8. The drape of claim 1,wherein the fluid-collection pouch is comprised of a polypropylene. 9.The drape of claim 1, wherein the fluid-collection pouch contains afilter.
 10. The drape of claim 1, wherein the drape further comprises acord fastener.
 11. The drape of claim 1, wherein the drape furthercomprises one or more channels to provide fluid communication betweenthe fenestration and the fluid-collection pouch.
 12. The drape of claim1, wherein the drape is a sterile drape.
 13. A packaged sterile surgicaldrape comprising the sterile drape of claim 1 and a package thatcontains the sterile surgical drape and maintains the sterility of thedrape.
 14. A cranial surgical drape to cover a patent during surgery,the drape comprising: a sheet having an interior surface for contactingthe cranial and thoracic regions of a surgical patient and an exteriorsurface for facing away from the patient after placement; a fenestrationin the cranial region; and a fluid-collection pouch on the exteriorsurface of the sheet surrounding and adjacent the fenestration in thecranial region fastened to the exterior surface and in communicationwith said fenestration in the cranial region; and a fenestration in thethoracic region.
 15. The drape of claim 14, wherein the fluid-collectionpouch comprises at least two reservoirs, said reservoirs being disposedon different sides of the cranial region fenestration.
 16. The drape ofclaim 14, wherein the drape comprises at least two fluid-collectionpouches.
 17. The drape of claim 14, wherein the drape comprises anadhesive layer on the interior surface of the drape surrounding thethoracic region fenestration.
 18. The drape of claim 14, wherein thedrape is a sterile drape.
 19. A packaged sterile surgical drapecomprising the sterile drape of claim 18 and a package that contains thesterile surgical drape and maintains the sterility of the drape.
 20. Acranial surgical drape to cover a patient during surgery, the drapecomprising: a sheet having an interior surface for contacting thecranial region of a surgical patient and an exterior surface for facingaway from the patient after placement; a fenestration in the cranialregion, wherein the sheet has a perimeter that defines the fenestration;a fluid-collection pouch on the exterior surface of the sheet adjacentto and surrounding a majority of the perimeter of the cranial regionfenestration, wherein the fluid-collection pouch is fastened to theexterior surface and is in fluid communication with the cranial regionfenestration; wherein the fluid-collection pouch comprises at leastthree reservoirs, wherein each of the reservoirs is on a different sideof the fenestration, a malleable strip at a top opening of the reservoiradapted for maintaining the reservoir in an open configuration; afenestration in the thoracic region; adhesive layers on the interiorsurface surrounding the cranial region and thoracic regionfenestrations; and a cord fastener.